PROJECT SUMMARY Aligned with critical research gaps identified as a priority for the National Occupational Research Agenda (NORA) Healthcare and Social Assistance (HCSA) sector over the next decade, this proposed study will address NORA strategic goals to: Promote safe and healthy workplaces and optimize safety culture in healthcare organizations; Reduce sharps injuries and their impacts among all healthcare personnel; and STOP transmission of infectious diseases in HCSA settings among workers, patients and visitors. This NIOSH Mentored Research Scientist Development Award supports the first step in a program of research that addresses three intertwined and important public health problems: 1) high rates of healthcare worker (HCW) blood-borne pathogen exposures; 2) high rates of patient healthcare associated infections (HAI); and 3) low levels of standard precaution adherence. The specific project aims are to: 1) describe the direction and magnitude of relationships among patient safety climate and self-reported and observed standard precaution adherence; 2) identify the relationship between standard precaution adherence and HCW blood-borne pathogen exposure and HAI; and 3) determine the direct and indirect relationships among patient safety climate, observed and reported standard precaution adherence, and HCW and HAI outcomes. To achieve these aims we will conduct a multi-site, cross-sectional study in a sample of 1600 hospital based nurses from 100 units in 50 U.S. hospitals and collect surveys on patient safety climate and standard precaution adherence, observational standard precaution adherence data, and existing unit level data on HCW blood-borne pathogen exposures and HAIs. Using novel tools developed and pilot tested by the PI we will recruit and train hospital based staff on observational surveillance methodology to foster the NORA Research to Practice (r2P) goals. We will pool data from these four sources and use advanced multilevel modeling, accounting clustering, and important hospital and nurse potential confounders to determine whether hospital units with better patient safety climate have better standard precaution adherence and also have better HCW and patient outcomes. Findings from this study may identify modifiable features of the safety climate that impede or facilitate the uptake of evidence-based recommendations for standard precaution behaviors, and are associated with better HCW and patient outcomes. Potential implications of this study include developing a model for surveillance methodology and training and generating actionable knowledge for institutional, governmental, and academic stakeholders of important and modifiable features of the patient safety climate to improve HCW and patent safety. To our knowledge, this study will be the first to examine these relationships, aligned with NORA strategic goals. To accomplish this study a carefully constructed career development plan will be implemented aligned with the NORA research priority to prepare highly trained scientists to address occupational safety and health critical issues. The long term goal of the plan is to prepare the candidate as a successful independent investigator with expertise in organizational factors that influence HCW behaviors and occupational health and patient safety outcomes. The immediate goals of the training plan are to provide the candidate with an opportunity to 1) engage in intensive and extensive training focused on occupational health and safety, survey methodology, advanced quantitative methods, and dissemination and translational science skills, and 2) conduct an independent research project examining the relationships among patient safety climate, standard precaution adherence and adverse HCW and patient outcomes. The Principal Investigator will be guided by a team of mentors and collaborators that include senior scientists and faculty with extensive experience in Occupational Health and Safety, Infection Prevention and Epidemiology, Survey methodology and Biostatistics, and support from two national professional organizations.